Pancreatic fistula physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Patients with pancreatic fistulas usually appear normal and in some they appear malnourished. Physical examination of patients with pancreatic fistulas is usually remarkable for infection, dyspnea, pleuritic chest pain and ascites.

Physical Examination

Physical examination of patients with internal pancreatic fistulas is usually normal or asymptomatic, on the other hand patients with external pancreatic fistulas can present with drainage of fluid.

Appearance of the Patient

• Most of the patients with pancreatic fistulas usually appear normal, but some might show the following the features:
  • Dehydration
  • Weight loss from malnourishment

Vital Signs

• Patients with pancreatic fistulas may present with fever when there is an infection.
• Tachycardia with regular pulse may present in some patients.

Skin

• Skin examination of patients with pancreatic fistulas is usually normal.

HEENT

• HEENT examination of patients with pancreatic fistulas is usually normal.

Neck

• Neck examination of patients with pancreatic fistulas is usually normal.

Lungs

• Pulmonary examination of patients with pancreatic fistulas may shows the following due to large pleural effusions:
  • Dyspnea
  • Cough
  • Wheezing
  • Pleuritic chest pain
  • Reduced breath sounds
  • Dullness to percussion

Heart

• Cardiovascular examination of patients with pancreatic fistulas is usually normal.

Abdomen

• Abdominal examination of patients with pancreatic fistulas is usually shows the following:

• Abdominal distension due to fluid accumulation which can lead to ascites.
• The ascites have the following physical examination findings:
  • Fluid wave
  • Shifting dullness
  • Dullness to percussion at the flanks
  • Weight loss
  • Anorexia
  • Weakness and severe malnutrition

• Vague abdominal pain
• Altered bowel habits which include:
  • Hematemesis
  • Melena or hematochezia

Back

• Back examination of patients with pancreatic fistulas is usually normal.

Genitourinary

• Genitourinary examination of patients with pancreatic fistulas is usually normal.

Neuromuscular

• Neuromuscular examination of patients with pancreatic fistulas is usually normal.

Extremities

• Extremities examination of patients with pancreatic fistulas is usually normal.